Author + information
- Yao Chang Wang1
Patient initials or identifier number
Relevant clinical history and physical exam
An 83 years -old male complained of chest tightness and shortness of breath for weeks.
Past history : Type B aortic dissection s/p op for 20 years, Hypertensive cardiovascular disease, atrial fibrillation.
Relevant test results prior to catheterization
Thallium 201 scan : Strong positive.
Relevant catheterization findings
LCx-M: 90% stenosis.
RCA-P to M: 90% stenosis.
RCA-D : chronic total occlusion.
After balloon predilation, we deployed a DES 2.5 x 20 mm to LCx-M lesion. After stenting, the patient suffered severe chest pain and blood pressure drop to 70/50mmHg. Angiography revealed retrograde dissection from LMCA to Aorta and antegrade dissection from LMCA to LAD occurred. Rescued stenting to LMCA with a DES 4.0 x 12 mm was performed immediately. Dissection from LM to Aorta was sealed and blood pressure returned to 120/70 mmHg. We performed IVUS study from LAD to LMCA and LCx to LMCA which revealed long intramural hematoma from proximal to distal portion of LAD and LCx. We deployed a DES 3.0 x 48 from LAD-P to M. The patient's symptoms subside and we stopped the procedure under stable condition.
“Good judgment comes from experience, and experience comes from bad judgment.” Complications are important part of the interventional cardiologist’s career. The best approach to the complications of percutaneous coronary intervention is to know the nature and course of the complications and to solve the problem immediately.